India should reject a blanket vaccine mandate, adopt a decentralised policy

In India, a decentralised targetted vaccine mandate policy, instead of a blanket one, would work better

The recent wave of Covid-19 infections across the United States has been a setback for employers, schools and universities who were readying to open their offices and campuses From a "no mask needed for the fully vaccinated" policy 50 days back to vaccines being made compulsory by both state administrations and private companies alike, the Covid-19 vaccine has become imperative for the recovery process from the pandemic.

Given the population size of India and the current pace of vaccinations in the country, the threat of future waves of Covid-19 infections still looms large. Recently, employer institutions (both government as well as private) along with public service provider businesses in the country have mandated the Covid-19 vaccine for their employees and customers, respectively.

But if there is a vaccine mandate issued in India, what would be the ideal strategy for implementing it?

When does a vaccine mandate make sense?

There is sufficient data to demonstrate that government-sponsored immunisation drives, such as the Universal Immunisation Programme (UIP) and Mission Indradhanush, have successfully increased vaccine coverage across India, resulting in the loss of fewer lives due to these infectious diseases. There is also documented evidence on how vaccine hesitancy among the Indian masses has stymied the efficient distribution and adoption of vaccines.

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A vaccine mandate has to balance potential global health risks against a possible violation of personal autonomy. Covid-19 remains a persistent major threat to public health, especially in India, where less than 10 per cent of the population is fully vaccinated. The economic fallout of the lockdowns and millions of Covid-19 infections have had severe repercussions on millions of families across the country. Hence, it makes sense for institutions to demand their employees to be fully vaccinated, particularly in roles that require human interaction.

However, there must be certain checks and balances in place when issuing a vaccine mandate. Authorities must consider the legal framework and other factors before going ahead with the process.

The legal aspect

There has never been a vaccine mandate ever issued either by the government or any private entity in the history of independent India. This raises the question, "Is making the vaccine compulsory allowed as per Indian law?" Though no law explicitly mentions the concept of vaccine mandates, specific provisions have been provided to the state to tackle public health crises, such as the one right now.

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The Disaster Management Act of 2005 paved the way for creating the National Disaster Management Authority (NDMA) by the Union government. Section 6 of the Act empowers the NDMA to formulate any policy to tackle disasters. Section 35 of the Act empowers the Union government to take necessary measures concerning disaster management, including issuing guidelines to state governments and non-governmental organisations. Hence, the current laws do provide the NDMA and Union government with the power to mandate vaccinations to tackle Covid-19.

What should be the contours of the vaccine mandate?

The first and foremost recommendation would be not to issue a blanket mandate covering all sections of society. For such a mandate could lead to unintended consequences like increasing vaccine hesitancy. The mandate should restrict itself to employer institutions (Union, states and local governments and private sector), educational institutions (both government and private), and public service provider businesses (restaurants, gyms, etc.).

Though the power of mandating the vaccine rests with the Union government, the decision must be decentralised to the local level, giving local authorities and private entities the freedom to mandate the vaccine when required. Institutions may be recommended to issue vaccine mandates before commencing work from offices for companies and offline classes for schools and universities. This can help reduce the risk factor for those stepping out of their homes for their work or studies.

There must also be mechanisms set in place by the government to promote and provide vaccines, especially to the informal sector. This will help in addressing any inequity that exists in the vaccination process.

Factors to consider

While the issuance of mandates is just the first step, various caveats need attention when doing so. Mandates should be allowed if the authority issuing them can produce proof of a sufficient supply of reliable and approved vaccines and have the capacity to arrange the vaccination drive for all those covered under the mandate. This would also mean that the authority issuing the mandate is solely responsible for the entire vaccination process, including covering all the costs incurred during procurement and inoculation.

The side effects of the Covid-19 vaccine can make some individuals unavailable for work for a few days post-vaccination. The mandate issuing authority should be responsible for putting in place a leave policy providing the necessary time for recovery for all those who take the vaccine post the mandate.

Though compulsory vaccination is a must as per the mandate, there must be an alternative for those who develop an allergy or a life-threatening response to the vaccine. The mandate, therefore, must be considerate to allow exemptions to those who cannot take the shot for health reasons. A regular and timely testing process can be made available for those exempted from the mandate instead of getting vaccinated.

There might also be instances of refusal to comply with the mandate. Though the concept of compulsory vaccinations might be harsh, the threat to public health by Covid-19 takes precedence in this case. The mandate must explicitly mention the implications of disregarding it. In cases of non-compliance post the declaration of the mandate, despite all the above provisions being instituted, the authority issuing the vaccine may be allowed to initiate action against those rejecting the mandate.

As the pandemic rages on into its second year, the concept of making the Covid-19 vaccine compulsory is gathering steam around the globe, with several countries issuing blanket mandates for accessing any public services. India, which has been one of the worst-hit nations by the pandemic, must focus on equitable distribution of the vaccine and rapidly increasing the vaccine coverage keeping in mind the possibility of future outbreaks.

In India, a targetted vaccine mandate policy, instead of a blanket one, will ensure both of the above and face minimum resistance from the general public. It will eventually expedite the vaccination process, especially for those who currently don't have access to or cannot afford it.

(Arjun Gargeyas is a research analyst for Takshashila Institution, and Shambhavi Naik is Head of Research, Takshashila Institution)

Disclaimer: The views expressed above are the authors' own. They do not necessarily reflect the views of DH.